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Cardioembolic Stroke

O’Carroll, Cumara B. MD, MPH; Barrett, Kevin M. MD, MSc

doi: 10.1212/CON.0000000000000419
Review Articles

ABSTRACT: Purpose of Review: Cardioembolic stroke is common and disproportionately more disabling than nonembolic mechanisms of stroke. Its incidence is expected to rise because of the age-related incidence of atrial fibrillation and an aging population. This article summarizes the different causes of cardioembolism and outlines current management guidelines.

Recent Findings: Since cardioembolic stroke is not a single disease entity, its diagnosis requires initial clinical suspicion and a comprehensive evaluation, including ECG, echocardiography, brain imaging, and cardiac monitoring. Atrial fibrillation is the most common cause of cardioembolic stroke, and anticoagulation is usually recommended. This article reviews risk stratification models to assist in the decision-making process and highlights the increased use of novel oral anticoagulants for stroke prevention in atrial fibrillation. New data support the importance of prolonged cardiac monitoring for diagnosing occult atrial fibrillation. Current data on other mechanisms of cardioembolic stroke, such as prosthetic heart valves and aortic arch atherosclerosis, are also presented, and the available evidence regarding patent foramen ovale closure in cryptogenic stroke is summarized.

Summary: Cardioembolism is an important cause of ischemic stroke, with diverse underlying mechanisms requiring a tailored approach to diagnosis, management, and prevention.

Address correspondence to Dr Cumara B. O’Carroll, Mayo Clinic Arizona, 13400 E Shea Blvd, Scottsdale, AZ 85259, ocarroll.cumara@mayo.edu.

Relationship Disclosure: Dr O’Carroll reports no disclosure. Dr Barrett serves on the editorial board of Neurology, has received research/grant support from the National Institute of Neurological Disorders and Stroke for serving on the executive committees of the CREST-2 and SHINE clinical trials, and receives publishing royalties from Wiley Blackwell.

Unlabeled Use of Products/Investigational Use Disclosure: Drs O’Carroll and Barrett report no disclosure.

© 2017 American Academy of Neurology